Chapter 13 Developmental Disorders

Nature of Developmental Psychopathology: An Overview Normal vs. Abnormal Development Developmental Psychopathology Study of how disorders arise and change with time Childhood is associated with significant developmental changes Disruption of early skills will likely disrupt development of later skills Developmental Disorders Diagnosed first in infancy, childhood, or adolescence Attention deficit hyperactivity disorder (ADHD) Learning disorders Autism Mental retardation

Attention Deficit Hyperactivity Disorder (ADHD): An Overview Nature of ADHD Central features – Inattention, overactivity, and impulsivity Associated with behavioral, cognitive, social, and academic problems DSM-IV and DSM-IV-TR Symptom Clusters Cluster 1 – Symptoms of inattention Cluster 2 – Symptoms of hyperactivity and impulsivity cluster Either cluster 1 or 2 must be present for a diagnosis

ADHD: Facts and Statistics Prevalence Occurs in 4%-12% of children who are 6 to 12 years of age Symptoms are usually present around age 3 or 4 68% of children with ADHD have problems as adults Gender Differences Boys outnumber girls 4 to 1 Cultural Factors Probability of ADHD diagnosis is greatest in the United States

The Causes of ADHD: Biological Contributions Genetic Contributions ADHD runs in families Familial ADHD may involve deficits on chromosome 20 Gene for the D4 receptor is more common in ADHD children Neurobiological Contributions: Brain Dysfunction and Damage Inactivity of the frontal cortex and basal ganglia Right hemisphere malfunction Abnormal frontal lobe development and functioning Yet to identify a precise neurobiological mechanism for ADHD

The Causes of ADHD: Biological Contributions (cont.) The Role of Toxins Allergens and food additives do not appear to cause ADHD Maternal smoking increases risk of having a child with ADHD

The Causes of ADHD: Psychosocial Contributions Psychosocial Factors Can Influence the Disorder Itself Constant negative feedback from teachers, parents, and peers Peer rejection and resulting social isolation Such factors foster low self-image

Biological Treatment of ADHD Goal of Biological Treatments To reduce impulsivity/hyperactivity and to improve attention Stimulant Medications Reduce the core symptoms of ADHD in 70% of cases Examples include Ritalin, Dexedrine Other Medications Imipramine and Clonidine (antihypertensive) have some efficacy

Biological Treatment of ADHD (cont.) Effects of Medications Improve compliance and decrease negative behaviors in many children Medications do not affect learning and academic performance Beneficial effects are not lasting following drug discontinuation

Behavioral and Combined Treatment of ADHD Behavioral Treatment Involve reinforcement programs Aim to increase appropriate behaviors and decrease inappropriate behaviors May also involve parent training Combined Bio-Psycho-Social Treatments Are highly recommended

Learning Disorders: An Overview Scope of Learning Disorders Problems related to academic performance in reading, mathematics, and writing Performance is substantially below what would be expected DSM-IV and DSM-IV-TR Reading Disorder Discrepancy between actual and expected reading achievement Reading is at a level significantly below that of a typical person of the same age Problem cannot be caused by sensory deficits (e.g., poor vision)

Learning Disorders: An Overview (cont.) DSM-IV and DSM-IV-TR Mathematics Disorder Achievement below expected performance in mathematics DSM-IV and DSM-IV-TR Disorder of Written Expression Achievement below expected performance in writing

Learning Disorders: Some Facts and Statistics Incidence and Prevalence of Learning Disorders 1% to 3% incidence of learning disorders in the United States Prevalence is highest in wealthier regions of the United States Prevalence rate is 10% to 15% among school age children Reading difficulties are the most common of the learning disorders About 32% of students with learning disabilities drop out of school School experience for such persons tends to be quite negative

Learning Disorders: Some Facts and Statistics (cont.) Figure 14.1 Half of school children classified as disabled have learning disabilities. Twenty years ago the proportion was 25%

Learning Disorders: Some Facts and Statistics (cont.) Figure 14.2 Uneven distribution of learning disabilities in the United States in the wealthiest states

Biological and Psychosocial Causes of Learning Disorders Genetic and Neurobiological Contributions Reading disorder runs in families, with 100% concordance rate for identical twins Evidence for subtle forms of brain damage is inconclusive Overall, genetic and neurobiological contributions are unclear Psychosocial Contributions are Largely Unknown

Treatment of Learning Disorders Requires Intense Educational Interventions Remediation of basic processing problems (e.g., teaching visual skills) Improvement of cognitive skills (e.g., instruction in listening) Targeting behavioral skills to compensate for problem areas Data Support Behavioral Educational Interventions for Learning Disorders

Pervasive Developmental Disorders: An Overview Nature of Pervasive Developmental Disorders Problems occur in language, socialization, and cognition Pervasive – Means the problems span the person’s entire life Examples of Pervasive Developmental Disorders Autistic disorder Asperger’s syndrome

The Nature of Autistic Disorder: An Overview Autism Significant impairment in social interactions and communication Restricted patterns of behavior, interest, and activities Three Central DSM-IV and DSM-IV-TR Features of Autism Problems in socialization and social function Problems in communication – 50% never acquire useful speech Restricted patterns of behavior, interests, and activities – Most striking feature!

Autistic Disorder: Facts and Statistics Prevalence and Features of Autism Rare condition – Affecting 2 to 20 persons for every 10,000 people More prevalent in females with IQs below 35, and in males with higher IQs Autism occurs worldwide Symptoms usually develop before 36 months of age Autism and Intellectual Functioning 50% have IQs in the severe-to-profound range of mental retardation 25% test in the mild-to-moderate IQ range (i.e., IQ of 50 to 70) Remaining people display abilities in the borderline-to-average IQ range Better language skills and IQ test performance predicts better lifetime prognosis

Causes of Autism: Early and More Recent Contributions Historical Views Bad parenting Unusual speech patterns Lack of self-awareness Ecolalia Current Understanding of Autism Medical conditions – Not always associated with autism Autism has a genetic component that is largely unclear Neurobiological evidence for brain damage – Link with mental retardation Cerebellum size – Substantially reduced in persons with autism Psychosocial Contributions Are Unclear

Asperger’s Disorder: Part of the Autistic Spectrum The Nature of Asperger’s Disorder Such persons show significant social impairments Restricted and repetitive stereotyped behaviors May be clumsy, and are often quite verbal (i.e., pedantic speech) Do not show severe delays in language and other cognitive skills Prevalence of Asperger’s Disorder Often under diagnosed Affects about 1 to 36 persons per 10,000 people Causes of Asperger’s Disorder Are Somewhat Unclear

Treatment of Pervasive Developmental Disorders: Example of Autism Psychosocial “Behavioral” Treatments Skill building and treatment of problem behaviors Communication and language problems Address socialization deficits Early intervention is critical Biological and Medical Treatments Are Unavailable Integrated Treatments: The Preferred Model Focus on children, their families, parents, schools, and the home Build in appropriate community and social support

Mental Retardation (MR): An Overview Nature of Mental Retardation Disorder of childhood Below-average intellectual and adaptive functioning Range of impairment varies greatly across persons Mental Retardation and the DSM-IV and DSM-IV-TR Significantly sub-average intellectual functioning (IQ below 70) Concurrent deficits or impairments in two or more areas of adaptive functioning MR must be evident before the person is 18 years of age

DSM-IV and DSM-IV-TR Levels of Mental Retardation (MR) Mild MR Includes persons with an IQ score between 50 or 55 and 70 Moderate MR Includes persons in the IQ range of 35-40 to 50-55 Severe MR Includes people with IQs ranging from 20-25 up to 35-40 Profound MR Includes people with IQ scores below 20-25

Other Classification Systems for Mental Retardation (MR) American Association of Mental Retardation (AAMR) Defines MR based on levels of assistance required Examples of levels include intermittent, limited, extensive, or pervasive assistance Classification of MR in Educational Systems Educable mental retardation (i.e., IQ of 50 to approximately 70-75) Trainable mental retardation (i.e., IQ of 30 to 50) Severe mental retardation (i.e., IQ below 30) Implications of Different MR Classification Systems

Mental Retardation (MR): Some Facts and Statistics Prevalence About 1% to 3% of the general population 90% of MR persons are labeled with mild mental retardation Gender Differences MR occurs more often in males, male-to-female ratio of about 6:1 Course of MR Tends to be chronic, but prognosis varies greatly from person to person

Causes of Mental Retardation (MR): Biological Contributions Genetic Research MR involves multiple genes, and at times single genes Chromosomal Abnormalities and Other Forms of MR Down syndrome – Trisomy 21 Fragile X syndrome – Abnormality on X chromosome Maternal Age and Risk of Having a Down’s Baby Nearly 75% of cases cannot be attributed to any known biological cause

Causes of Mental Retardation (MR): Biological Contributions (cont.) Figure 14.3 The increasing likelihood of Down syndrome with maternal age

Causes of Mental Retardation (MR): Psychosocial Contributions Cultural-Familial Retardation Believed to cause about 75% of MR cases and is the least understood Associated with mild levels of retardation on IQ tests and good adaptive skills Cultural-Familial Retardation: Difference vs. Develop- mental Views Difference view – Mild MR is a matter of degree and kind Developmental view – Mild MR reflects a slowing or delay of normal development

Treatment of Mental Retardation (MR) Parallels Treatment of Pervasive Developmental Disorders Teach needed skills to foster productivity and independence Educational and behavioral management Living and self-care skills via task analysis Communication training – Often most challenging treatment target! Community and supportive interventions Persons with MR Can Benefit from Such Interventions

Summary of Developmental Disorders Developmental Psychopathology and Normal and Abnormal Development Attention Deficit Hyperactivity Disorder Deficits in attention, hyperactivity, or impulsivity Disrupt academic and social functioning Learning Disorders All share deficits in performance below expectations for IQ and school preparation Pervasive Developmental Disorder All share deficits in language, socialization, and cognition Mental Retardation Sub-average IQ, deficits in adaptive functioning, onset before age 18 Prevention and Early Intervention Are Critical for Developmental Disorders

Summary of Developmental Disorders (cont.) Figure 14.x1 Exploring developmental disorders, attention deficit/hyperactivity disorder, learning disorders, and communication disorders

Summary of Developmental Disorders (cont.) Figure 14.x1 (cont.) Exploring developmental disorders, attention deficit/hyperactivity disorder, learning disorders, and communication disorders

Summary of Developmental Disorders (cont.) Figure 14.x2 Exploring developmental disorders, pervasive developmental disorders, mental retardation

Summary of Developmental Disorders (cont.) Figure 14.x2 (cont.) Exploring developmental disorders, pervasive developmental disorders, mental retardation